Pulmonary infections

Question 1

Parapneumonic effusion / empyema in CAP

Answer 1

Strep Milleri
Strep pneumonia
Staph aureus
Anaerobes

Question 2

Parapneumonic effusion/ empyema in HAP

Answer 2

MRSA
Staph aureus
Enterobacter
Enterococci

Question 3

Lemierre’s sundrome

Answer 3

Fusobacterium

Question 4

Latent TB: diagnosis, treatment

Answer 4

Mantoux >5mm or positive IGRA

Treat: 3 months rifampicin and isoniazid
or 6 months isoniazid - for people with HIV

Question 5

NTM - MAC treatment

Answer 5

Triple therapy with macrolide - clarithromycin/azithromycin + rifampicin + ethambutol
Add neb/IV amikacin or IV streptomycin in severe disease
Continue for at least 12 months

Macrolide resistance - isoniazid or quinolone

Question 6

NTM - M kansasii

Answer 6

upper lobe fibrocavitary disease

Rifampicin + ethambutol + isoniazid 12 months of neg samples
if rifam resistant - clarithromycin and moxifloxacin

Question 7

NTM - M. Malmoense

Answer 7

COPD

Rifampicin + ethambutol + macrolide 12 months after

Question 8

NTM - M. Xenopi

Answer 8

upper lobe cavitating

Rifampicin + ethambutol + macrolide + isoniazid/quinolone

high mortality

Question 9

NTM - M gordonae

Answer 9

usually contaminant

Question 10

NTM - M abscessus

Answer 10

CF
causes nodular/bronchietatic disease in patients without CF
non-smoking female

4 weeks - IV amikacin + tigecycline + imipenem + PO azithromycin (2nd line IV cefoxitin)
long term maintenance - nebs amikacin + PO azithromycin + 1-3 other PO (quinolone, clofazimine, minocycline, co-trimoxazole, linezolid)

Question 11

NTM - M Chelonae

Question 12

CURB65

Answer 12

Confusion AMTS <8
Urea >7mmol/L
RR >30
BP <90 systolic; <60 diastolic
Age >65

0-1 <3%
2 9%
3-5 15-40%

Question 13

Lemierres Disease

Answer 13

fusobacterium necrophorum
orophargyngeal infection
internal jugular vein thrombosis
abscess - pulmonary, cerebral
young patient

Question 14

Cavitating organisms

Answer 14

Strep
staph
Klebsiella
Nocardia
Haemophillus
Fungal
Fusobacterium

Question 15

ABPA - criteria for diagnosis

Answer 15

Acute or subacute clinical deterioration

1) skin prick/IgE +ve to aspergillus fumigatus
2) IgG to aspergillus fumigatus
3) Central (proximal) bronchiectasis
4) Blood/sputum eosinophils

5) total serum IgE >1000 IU/ml
6) Lung infiltrates - flitting

Question 16

ABPA - management

Answer 16

PO Pred 0.5-1mg/kg 2 weeks then taper over 2-3 months
Add itraconazole 5mg/kg/day max 200mg BD 3-6 months
Check LFTs 1 and 3 months

Question 17

SE of antifungals

Answer 17

Transaminitis
skin rash
visual disturbance
GI disturbance
Peripheral neuropathy

Question 18

PCP risk factors

Answer 18

HIV CD4 <200
Chemo
Steroids
Immunosuppression
Malnutrition
Post-transplant
Malignancy

Question 19

Risk factors for invasive aspergillosis

Answer 19

Chemo
Neutropaenic
stem cell transplant - bone marrow suppression
HIV
Transplant - immunotherapy
Infliximab therapy - anti-TNFa
COPD
Critical illness